Cumulative trauma disorders: An overview of the problem

Cumulative trauma disorders—which result from highly-repetitive job activities, sustained loads, and exposure to vibratory forces—are rapidly spreading through the industrialized world. As their prevalence increases, so do the economic and social consequences. This paper provides an overview of the problem to illustrate the fact that addressing the rising incidence of CTDs requires a multidisciplinary approach involving research and programmatic efforts directed on many fronts, most notably medicine, engineering, management, occupational health, and government. After a review of the diagnosis and treatment of cumulative trauma disorders is presented, the importance of ergonomic analysis for identifying workers at risk is discussed. Some prevention strategies currently being implemented in workplaces around the country are also described. Finally, we raise important industry and public policy issues which need to be confronted if the incidence of CTDs is to be reduced and costs of the workers' compensation system contained.     

"Let's Talk Back": a program to empower laundry workers.

Laundry workers have traditionally been offered little input into the ergonomic and health and safety aspects of their jobs. The "Let's Talk Back" program was developed in response to worker demands, in order to empower them to effectively address some of these concerns. The program, endorsed by the union and administered by a hospital ergonomist, provided formal educational sessions, physical demand analyses, and a forum in which to communicate concerns and suggestions for improvements. Language and/or literacy barriers required innovative educational approaches. Management's reluctance to allow the program to interfere with production schedules hindered the efficiency of the program, but probably contributed to the sense of empowerment in the workforce. Through active participation in ergonomic assessments as well as the educational program, workers were able to demonstrate to management that changes were needed.     

Human factors and ergonomics methods for pharmacy research and clinical practice

BackgroundHuman factors and ergonomics (HFE) is a scientific and practical human-centered discipline that studies and improves human performance in sociotechnical systems. HFE in pharmacy promotes the human-centered design of systems to support individuals and teams performing medication-related work.ObjectiveTo review select HFE methods well suited to address pharmacy challenges, with examples of their application in pharmacy.MethodsWe define the scope of HFE methods in pharmacy as applications to pharmacy settings, such as inpatient or community pharmacies, as well as medication-related phenomena such as medication safety, adherence, or deprescribing. We identify and present seven categories of HFE methods suited to widespread use for pharmacy research and clinical practice.ResultsCategories of HFE methods applicable to pharmacy include work system analysis; task analysis; workload assessment; medication safety and error analysis; user-centered and participatory design; usability evaluation; and physical ergonomics. HFE methods are used in three broad phases of human-centered design and evaluation: study; design; and evaluation. The most robust applications of HFE methods involve the combination of HFE methods across all three phases. Two cases illustrate such a comprehensive application of HFE: one case of medication package, label, and information design and a second case of human-centered design of a digital decision aid for medication safety.ConclusionsPharmacy, including the places where pharmacy professionals work and the multistep process of medication use across people and settings, can benefit from HFE. This is because pharmacy is a human-centered sociotechnical system with an existing tradition of studying and analyzing the present state, designing solutions to problems, and evaluating those solutions in laboratory or practice settings. We conclude by addressing common concerns about the implementation of HFE methods and urge the adoption of HFE methods in pharmacy.     

Carpal tunnel syndrome prevalence: an evaluation of workers at a raw poultry processing plant

Objectives: Evaluate the prevalence of carpal tunnel syndrome (CTS) among workers at a raw poultry processing plant and categorize jobs on the basis of hand activity and force.

Methods: A cross-sectional survey among 191 workers assessed CTS defined by self-reported CTS symptoms, a hand symptom diagram, and measurements of nerve conduction parameters. We categorized jobs based on American Conference of Governmental Industrial Hygienists’ (ACGIH®) limits for hand activity and force, and examined the relationships with CTS occurrence.

Results: A total of 64 workers (34%) had CTS after adjusting for non-occupational factors. Overall, 81% of jobs were above the ACGIH action limit; 59% were above the ACGIH threshold limit value®. CTS prevalence did not differ significantly between exposure groups (PR = 0.82, p = 0.35).

Conclusions: These findings suggest that poultry processing jobs continue to be hazardous with workers at risk for CTS. Recommendations for the study population were provided to reduce exposure and CTS risk among workers.     

Determinants of physical and mental health complaints in dentists: a systematic review

Occupational determinants of ill health in dentists were systematically reviewed in literature. The methodological quality of the studies was evaluated. Studies were included if they evaluated health‐related risk factors in dental practice by means of quantitative methods and statistical analysis of collected data. Despite all the factors affecting dentists' physical and mental health, evidence of the predictive value of all these risk factors remains scarce. More than one‐third (37%) of the studies appraised were found to be low quality research (weak or invalid). Results from studies investigating the factors associated with ill health in dentists do not allow for conclusions at the meta‐level. More prospective and retrospective case‐control studies should be conducted and attention should be paid to measuring outcomes with validated instruments to enable comparative studies and statistical summation of findings.     

Developing Evidence‐Based Interventions to Address the Leading Causes of Workers' Compensation Among Healthcare Workers

Overexertion and slip, trip, and fall (STF) incidents are two of the leading sources of workers' compensation claims and costs in healthcare settings ( Bell et al., 2008 ; Bureau of Labor Statistics [BLS], 2008 ). Working in conjunction with a team of international researchers, the National Institute for Occupational Safety and Health (NIOSH) has been conducting research to demonstrate the effectiveness of comprehensive safe patient handling and STF‐prevention programs. The purpose of this article is to summarize the research and outreach efforts of NIOSH and their partners to address the leading occupational injury hazards facing healthcare workers. This article also provides an overview of the changes that are occurring in the healthcare industry as a result of the evidence‐based research on safe patient handling and STF prevention that has been conducted in recent years.     

A randomized,controlled trial of the efficacy of closed chest compressions in ambulances

Objective. To examine the feasibility of closed chest compressions in ambulances.

Methods. Ten male emergency medical technicians performed closed chest compressions on a Laerdal Skillmeter Resusci Anne placed 1) on the ground, 2) on the stretcher of an MB 510 ALS ambulance, 3) on the stretcher of an MB 310 ambulance, and 4) on the stretcher of a VW T4 BLS ambulance for 2 minutes each. The authors noted the percentage of correct compressions as shown by the mannequin and counted the heart rate of the participants before and after each session. The authors compared the percentage of correct compressions and the increase in heart rate during the three ambulance sessions with those of the session on the ground by rank order test for paired observations. A p < 0.05 after Bonferroni correction (factor 3) was considered significant.

Results. The percentage of correct compressions was 90% ± 7% on the ground, 77% ± 19% in the MB 510,60% ± 31% in the MB 310, and 38% ± 24% in the VW T4. Heart rate increase was 18 ± 16 min^?1 on the ground, 23 ± 9 min^-1 in the MB 510,30 ± 16 min^-1 in the MB 310, and 32 ± 13 min^-1 in the VW T4. Only the difference in percentage of correct compressions between on the ground and the VW T4 was significant (p < 0.01 after Bonferroni correction).

Conclusions. The percentage of correct compressions in all the vehicles tested was lower when compared with the percentage on the ground, and the increase in heart rate was higher. Only one of these results was statistically significant. A further study with more participants seems warranted.